1 / 22

The Arguments Against

The Arguments Against. Dr. Anthony G. Crocco. Why listen to me?. Deputy Chief - McMaster Children’s Hospital ER Pediatric Consultant - BEEM Tutor - EBCP Course Member - PERC International Educator No industry sponsorship. The Argument Against. Research problems :

baba
Download Presentation

The Arguments Against

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. The Arguments Against • Dr. Anthony G. Crocco

  2. Why listen to me? • Deputy Chief - McMaster Children’s Hospital ER • Pediatric Consultant - BEEM • Tutor - EBCP Course • Member - PERC • International Educator • No industry sponsorship

  3. The Argument Against • Research problems: • How the evidence was presented • Risk of the unknown • A researcher’s story • The true value of this paper

  4. Plint - 2009 • “Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions.”

  5. Plint - 2009

  6. Plint - 2009 • “Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may (NOT) significantly reduce hospital admissions.”

  7. Plint - 2009 • “our results should be considered exploratory” • “confirmation of our findings by a study powered specifically to compare combined epinephrine and dexamethasone therapy with placebo is needed”

  8. Steroids safe?

  9. Steroids safe? • False belief that systemic steroids in premature infants was safe • Developmental delay (Barrington 2001)

  10. Steroids safe? • False belief that inhaled steroids had no effect on long-term height • 1.2cm difference (Kelly 2012)

  11. Steroids safe?

  12. A Researcher’s Story... • What would you do if...?

  13. The True Value • Exciting and unexpected synergy between epinephrine and steroid use • Clinically confirms evolving understanding of cellular receptors • Future work needs to be done to find the lowest, shortest and safest dosing

  14. Conclusions • Results that may benefit, may not benefit! • No confidence lines? No confident results! • First do no harm! Beware of myopia! • The researchers are not suggesting routine use and would not use it on their own family!

  15. The Arguments Against • Dr. Anthony G. Crocco

More Related